Provider Demographics
NPI:1629108121
Name:BRYANT, NANCY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53658 MARK DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507-9710
Mailing Address - Country:US
Mailing Address - Phone:574-286-0030
Mailing Address - Fax:574-234-1994
Practice Address - Street 1:928 E WAYNE ST
Practice Address - Street 2:SUITE C
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3024
Practice Address - Country:US
Practice Address - Phone:574-286-0030
Practice Address - Fax:574-234-1994
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004946A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000373892OtherBLUE CROSS BLUE SHIELD